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Objectives To examine the clinical meaningfulness of changes observed in functional performance from two self-directed interventions targeting adults with arthritis. Study design Randomized controlled trial. Methods Participants ( n = 312) were randomized to a 12-week self-directed exercise or nutrition intervention. Objective measures of functional performance (6-minute walk, seated reach, grip strength, 30-second chair stand, gait speed, balance) were obtained at baseline, 12 weeks, and nine months. Minimally (≥0.20 standard deviation) and substantially (≥0.50) meaningful changes in functional performance were examined. Changes in the percent ‘impaired’ and at risk for losing independence using established standards, and associations between physical activity and impairment/risk status were also examined. Group × Time interactions were not significant; therefore groups were combined in all analyses. Results Minimally (31–71%) and substantially (13–54%) meaningful changes in function were shown. There was a significant decrease in the percentage of participants ‘impaired’ on the 30-second chair stand (both time points) and gait speed (nine months). The percentage of participants at risk for losing independence significantly decreased for the 30-second chair stand (both time points) and the 6-minute walk (nine months). Those engaging in ≥2 h of leisure-time physical activity were significantly less likely to be impaired on the 6-minute walk, 30-second chair stand, and gait speed at 12 weeks, and the 6-minute walk at nine months. Conclusions Interventions that can slow functional declines, and ideally result in clinically meaningful improvements in functional performance among adults with arthritis are needed. Meaningful improvements in various indicators of functional performance can result from self-directed exercise and nutrition programs. These types of programs have the potential for wide-spread dissemination, and thus broad reach.

Background Despite the established benefits of exercise for adults with arthritis, participation is low. Safe, evidence-based, self-directed programs, which have the potential for high reach at a low cost, are needed. Purpose To test a 12-week, self-directed, multicomponent exercise program for adults with arthritis. Design Randomized controlled trial. Data were collected from 2010 to 2012. Data were analyzed in 2013 and 2014. Setting/participants Adults with arthritis (N=401, aged 56.3 [10.7] years, 85.8% women, 63.8% white, 35.2% African American, BMI of 33.0 [8.2]) completed measures at a university research center and participated in a self-directed exercise intervention (First Step to Active Health ® ) or nutrition control program (Steps to Healthy Eating). Intervention Intervention participants received a self-directed multicomponent exercise program and returned self-monitoring logs for 12 weeks. Main outcome measures Self-reported physical activity, functional performance measures, and disease-specific outcomes (arthritis symptoms and self-efficacy) assessed at baseline, 12 weeks, and 9 months. Results Participants in the exercise condition showed greater increases in physical activity than those in the nutrition control group ( p =0.01). Significant improvements, irrespective of condition, were seen in lower body strength, functional exercise capacity, lower body flexibility, pain, fatigue, stiffness, and arthritis management self-efficacy ( p values Conclusions The exercise program improves physical activity, and both programs improve functional and psychosocial outcomes. Potential reasons for improvements in the nutrition control condition are discussed. These interventions have the potential for large-scale dissemination. This study is registered at Clinicaltrials.gov NCT01172327.

The use of video gaming as a therapeutic intervention has increased in popularity; however, the number of repetitions in comparison with traditional therapy methods has yet to be investigated. The primary purpose of this study was to document and compare the number of repetitions performed while playing 1 of 2 video gaming systems for a time frame similar to that of a traditional therapy session in individuals with chronic stroke.Twelve participants with chronic stroke (mean age, 66.8 ± 8.2 years; time poststroke, 19.2 ± 15.4 months) completed video game play sessions, using either the Nintendo Wii or the Playstation 2 EyeToy. A total of 203 sessions were captured on video record; of these, 50 sessions for each gaming system were randomly selected for analysis. For each selected record, active upper and lower extremity repetitions were counted for a 36-minute segment of the recorded session.The Playstation 2 EyeToy group produced an average of 302.5 (228.1) upper extremity active movements and 189.3 (98.3) weight shifts, significantly higher than the Nintendo Wii group, which produced an average of 61.9 (65.7) upper extremity active movements and 109.7 (78.5) weight shifts. No significant differences were found in steps and other lower extremity active movements between the 2 systems.The Playstation 2 EyeToy group produced more upper extremity active movements and weight shifting movements than the Nintendo Wii group; the number and type of repetitions varied across games. Active gaming (specifically Playstation 2 EyeToy) provided more upper extremity repetitions than those reported in the literature by using traditional therapy, suggesting that it may be a modality to promote increased active movements in individuals poststroke.

Background and Purpose: Intensive mobility training (IMT) is a rehabilitative approach aimed at improving gait, balance, and mobility through the incorporation of task-specific, massed practice. The purpose of this case series was to examine the feasibility and benefits of the IMT protocol across a sample of 4 individuals with diverse chronic neurological diagnoses, including incomplete spinal cord injury, Parkinson's disease, stroke, and cerebral hemispherectomy. Methods: The 4 participants enrolled in the IMT protocol and followed an intensive treatment schedule of 3 h/d sessions for 10 consecutive weekdays totaling 30 hours. Each session allocated 1 hour each to (1) body weight-supported treadmill-based locomotor training, (2) balance interventions, and (3) activities to improve coordination, strength, and range of motion. Interventions emphasized repetitive, task-specific training of lower-extremity movements in a massed practice schedule. Pain, fatigue, and time in activity were used to assess feasibility of the treatment. Temporal-spatial gait parameters, Berg Balance Scale, Dynamic Gait Index, Timed Up and Go test, and 6-Minute Walk test were used to assess changes in performance. Results: Participants were able to complete an average of 144 of 180 minutes of activity per day for 10 days. Participants demonstrated modest improvements after the intervention on at least one outcome measure for each target area of gait, mobility, and balance. Some improvements were maintained for 1 to 6 months after participation. Discussion: Despite differences in diagnosis among these participants with chronic neurological disorders, on average they were able to complete 80% of an intensive treatment schedule of 3 hours/day for 10 days with no adverse effects. It appears that some gains made during participation are maintained for a period of time after the end of training. IMT is a feasible intervention incorporating an intensive training approach to improve gait, balance, and mobility; however, a randomized trial is needed to further investigate the effects of the intervention.

This study investigated the relative performance of two computer input devices appropriate for persons sharing similar motor challenges: a head operated device and expanded membrane cursor keys. Performance was evaluated in the context of a Fitts' law target acquisition task. For this initial phase of investigation, subjects without disabilities were selected to focus on performance differences inherent in the devices and their operation. Results indicated that the total time to acquire a target was significantly faster for the head device than for the expanded cursor keys. For typical young adults, the head-operated device required less time to reach asymptote performance by simplifying the cognitive demands for device operation. These results suggest that for persons unable to isolate their fingers, head-operated controls may offer advantages over input devices operated by the upper extremities.

Children and adults with disabilities frequently rely on computers to complete written tasks. Those with significant motor limitations typically use alternative computer-input devices since the traditional keyboard and mouse are insufficient to accommodate their abilities. For persons unable to isolate their fingers, input devices controlled by movements of the head or whole hand or arm movements may be among the options considered. This study investigated the performance of a head-operated device and expanded membrane cursor keys for text entry. Data from 24 young adults indicated the head-operated device performed significantly faster given reduced cognitive demands for device operation, increased stimulus–response compatibility, and simplicity of movement. Use of the expanded membrane cursor keys resulted in significantly lower error rates. No significant differences in comfort or ease of use were reported for the two devices. The relative performance of device options for users sharing similar motor challenges provides rehabilitation specialists with important clinical information.

McGraw B, McClenaghan BA, Williams HG, Dickerson J, Ward DS. Gait and postural stability in obese and nonobese prepubertal boys. Arch Phys Med Rehabil 2000;81:484-9. Objective: To examine differences in gait and postural stability of obese and nonobese prepubertal boys. Design: Percentage of gait cycle in double support was examined to determine significant differences. Postural stability was compared using temporal and frequency measures of the center of pressure in static stance. Setting: Gait was examined using videography on a 30-meter walkway. Postural stability was examined using a measurement platform. Participants: Ten obese (>95th percentile in body mass index) and 10 nonobese (15th to 90th percentile in body mass index) prepubertal boys aged 8 to 10yrs. Intervention: Participants were examined at three walking cadences as determined by preferred gait cadence. Full vision, darkness, and visually confused conditions were used to accentuate static postural stability differences. Main Outcome Measures: In the presence of dynamic stability differences (gait), static stability measures further investigated stability differences. Results: Obese boys spent significantly ( p p Conclusions: Dual stance differences suggest diminished dynamic stability in obese boys. Greater sway areas in medial/lateral direction in obese boys and the absence of significant frequency measures suggest that the instability observed in obese boys is caused by excess weight rather than underlying postural instability. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Objective: To examine the feasibility of using spectral analysis techniques to identify potential biomarkers of diminished postural control in elderly individuals. Design: Data from spectral signatures (derived from postural sway) of 21 young adults and 42 elderly individuals classified as "high" or "low" risk with regard to functional balance capacity were analyzed using Risk Category (3) × Sensory Condition (3) multivariate analyses of variance. Postural control was challenged by varying the visual conditions under which individuals stood on a measurement platform. Results: Results indicated that measures of central tendency and dispersion of the spectral frequency distribution from medial-lateral components of sway (but not antero-posterior sway) clearly differentiated between "high" and "low" risk elderly. Low risk elderly were not different from young adults. High risk elderly exhibited greater dispersion and lower mean frequency than other groups. Conclusions: Differences in spectral characteristics of medial-lateral components of sway were more related to risk category than to age. Elderly persons with high functional balance capacity displayed characteristics similar to those of young adults. Thus, spectral frequency analysis techniques may be a clinically useful tool for identifying individuals potentially at risk of falling.

The purpose of this study was to apply techniques of spectral analysis to the study of postural control and determine if aging results in changes to spectral parameters obtained from postural forces. Subjects were young adults and elderly who live independently and had no difficulty performing tasks of daily living. Ground reaction forces were obtained from a measurement plat-form during repeated trials of static standing. Forces were analyzed using spectral analysis and selected parameters (central tendency and dispersion) were extracted from averaged spectral data. Significant differences were observed between age groups in all parameters extracted from spectra obtained from medial-lateral postural forces. Similar results were not obtained for data in the anterior-posterior direction. Results suggest that aging affects the spectral characteristics of postural forces used to maintain stability in the m-l direction.

BackgroundEvidence-based practice promotes patient-centered care, yet the majority of rehabilitative research fails to take patient perspectives into consideration. Qualitative research provides a unique opportunity for patients to express opinions and provide valuable insight on intervention processes.ObjectiveThe purpose of this study was to assess the feasibility of a novel, intensive, task-specific intervention from the patient's perspective.DesignA phenomenological approach to qualitative inquiry was used.MethodsEight individuals with chronic stroke participated in an intensive intervention, 3 hours per day for 10 consecutive days. Participants were interviewed twice regarding their impressions of the therapy, and a focus group was conducted with participants and family members. Data analysis included an analytical thematic approach.ResultsFive major themes arose related to the feasibility of the intervention: (1) a manageable amount of fatigue; (2) a difficult, yet doable, level of intensity; (3) a disappointingly short therapy duration; (4) enjoyment of the intervention; and (5) muscle soreness.ConclusionsThe findings suggest that participants perceived this novel and intensive, task-specific intervention as a feasible therapeutic option for individuals with chronic stroke. Despite the fatigue and muscle soreness associated with intensive rehabilitation, participants frequently reported enjoying the therapy and stated disappointment with the short duration (10 days). Future research should include a feasibility trial of longer duration, as well as a qualitative analysis of the benefits associated with the intervention.

This study proposes a methodology for the collection and analysis of the spectral characteristics of human movement patterns. Specifically, the purpose of this study was to determine the reliability of the spectral signature obtained from postural forces and the usefulness of the technique in identifying perturbations in standing posture. Data collected included trials of the experimental protocol under normal standing conditions and under three experimental conditions designed to perturb stability. Results of this investigation indicated that spectral signatures created from ground forces using the methodology proposed in this study were highly reliable within individuals and across different testing sessions. These data further indicate that spectral signatures obtained from ground reaction forces during standing provide a sensitive indicator of an individual's postural stability.

Falls and fall-related injuries are a major public health concern, a financial challenge for health care providers, and critical issues for older adults. Poor balance and limited mobility are major risk factors for falls.The purpose of this study was to examine effects of Feldenkrais exercises in improving balance, mobility, and balance confidence in older adults.Participants (N = 47, mean age 75.6) were randomly assigned to a Feldenkrais group (FG, n = 25) or to a control group (CG, n = 22). The FG group attended a 5-week Feldenkrais program, 60 minutes three times per week, while the CG group was a waitlist control. The outcome measures were balance (tandem stance), mobility (Timed Up and Go), gait characteristics (GAITRite Walkway System), balance confidence (Balance Confidence Scale; ABC), and fear of falling (Falls Efficacy Scale). Pre- and post-tests were conducted.After completion of the program, balance (p = 0.030) and mobility (p = 0.042) increased while fear of falling (p = 0.042) decreased significantly for the FG group. No other significant changes were observed. However, participants of the FG group showed improvements in balance confidence (p = 0.054) and mobility while performing concurrently a cognitive task (p = 0.067).These results indicate that Feldenkrais exercises are an effective way to improve balance and mobility, and thus offer an alternative method to help offset age-related declines in mobility and reduce the risk of falling among community-dwelling older adults. A long-term follow-up study of balance and mobility is warranted. Further research is needed to identify whether Feldenkrais exercises may impact cognitive processes.

PURPOSE This study explored the usefulness of measures commonly employed in the examination of persons with balance impairment to discriminate between performances of young and older adults and older adults with and without neurological disease. METHODS Eighteen young adults, 22 healthy older adults, 12 individuals with Parkinson disease, and 20 older adults with peripheral neuropathy were recruited from the community.Performances on the following measures were compared: Mini Mental State Exam, grip strength, timed chair rise, semitandem and tandem stance, Timed Up and Go (TUG), and Berg Balance Scale (BBS). Survival analysis was used to analyze semitandem and tandem stance. Grip strength and other tests were analyzed using analysis of variance. Tukey multiple comparison procedure was employed to assess differences in performance among groups. RESULTS Significant differences in performance were found for all measures. Grip and timed chair rise discriminated young and older adult groups. Timed chair rise, tandem stance, TUG, and BBS detected differences between healthy individuals and those with disease. Semitandem stance and BBS discriminated between individuals with disease conditions. CONCLUSIONS When examining individuals with balance difficulty, combinations of measures are needed to discriminate between clinically distinct groups.

This study investigated the effects of seat-surface inclination on parameters of postural stability and functional use of the upper extremity. 10 non-impaired children and 10 children with cerebral palsy, aged between four and 15 years, were studied. Seat-surface inclinations of 0 degree, 5 degrees anteriorly and 5 degrees posteriorly were used as the experimental conditions. Significant differences were observed on most dependent measures between the two groups. The results suggest that anteriorly tilting the seats of children with cerebral palsy may disturb postural stability, without improving performance of the upper extremity.

The purpose of this study was to examine the effects of selected types of feedback on the performance of an anticipation timing task by moderately mentally retarded children. Seventeen children, aged 10 to 16 years and classified as moderately mentally retarded (IQ = 44, range 32-54) participated as subjects for this investigation. Subjects were required to perform a key press response in anticipation to the arrival of a stimulus light. Data were analyzed utilizing a 4(treatment) × 2(gender) × 3(group) analysis of variance on the dependent variables. No significant main or interactive effects were found. Several possible explanations may account for these results including, (a) age range of the subjects may have biased the results, (b) the moderately retarded child may have had insufficient motor skills to successfully perform the tasks, (c) the personality characteristics of the subjects prevented them from perceiving their impact on performance, and/or (d) the type of feedback provided may not have been appropriately interpreted by the subjects.

Researchers of the future will depend upon computer technology to address questions that previously could not be answered using traditional methods of data acquisition. Recent advances in computer design and software availability have eliminated many of the limitations previously associated with computer use in the laboratory setting. Although computerisation facilitates the acquisition of laboratory data, identification of errors introduced into the measurement is often more difficult. The laboratory computer is only one component of an automated data acquisition system. A system designed to collect physiological data comprises several primary components, including: (a) sensing element; (b) signal amplification/conditioning circuits; (c) analogue display; (d) computer interface; (e) laboratory computer; and (f) acquisition software. The acquisition and conditioning of analogue signals is accomplished using traditional laboratory procedures familiar to the researcher. Converting this analogue signal into a digital format used by the computer, however, represents new techniques. Fundamentals of computerised data acquisition are discussed. An understanding of how an automated data acquisition system is configured and the techniques used to transform the values will assist the user in identifying sources of error introduced into the measurement. Additionally, familiarization with the methods of computerisation will provide insight into future applications of computer technology in the human performance laboratory.

The purpose of this study was to design and evaluate the validity of an automated technique to assess body density using a computerized hydrostatic weighing system. An existing hydrostatic tank was modified and interfaced with a microcomputer equipped with an analog-to-digital converter. Software was designed to input variables, control the collection of data, calculate selected measurements, and provide a summary of the results of each session. Validity of the data obtained utilizing the automated hydrostatic weighing system was estimated by: evaluating the reliability of the transducer/computer interface to measure objects of known underwater weight; comparing the data against a criterion measure; and determining inter-session subject reliability. Values obtained from the automated system were found to be highly correlated with known underwater weights (r = 0.99, SEE = 0.0060 kg). Data concurrently obtained utilizing the automated system and a manual chart recorder were also found to be highly correlated (r = 0.99, SEE = 0.0606 kg). Inter-session subject reliability was determined utilizing data collected on subjects (N = 16) tested on two occasions approximately 24 h apart. Correlations revealed high relationships between measures of underwater weight (r = 0.99, SEE = 0.1399 kg) and body density (r = 0.98, SEE = 0.00244 g X cm-1). Results indicate that a computerized hydrostatic weighing system is a valid and reliable method for determining underwater weight.

Research in motor control indicates that there are fixed patterns of activity which occur in certain muscle groups involved in standing in adults. The purpose of this study was to assess patterns of duration of muscle activity during quiet standing with and without superimposed arm movement in young children with normal and delayed motor development. Thirty-three children 4, 6, 8 and 10 years of age were screened for level of motor development and classified as either normally or slowly developing. Children performed two tasks: standing and standing with a superimposed 90 degree shoulder abduction movement. Using surface electrodes, EMG activity was monitored in Gastrocnemius, Tibialis Anterior and Erector Spinae muscle groups. The percentage of time activity was present in individual muscle groups was analyzed as a function of age and developmental level. Results indicated that quiet standing in children with delayed motor development was characterized by greater duration of activity in trunk than in leg muscles while in normal children, there was a more equal distribution of muscle activity between the legs and trunk. Both groups of children accommodated superimposed arm movement by increasing the percentage of time Erector Spinae activity was present. Patterns of duration of muscle activity in the legs were, however, different for the two groups of children.